Summary
Interstitial pneumonia caused by Herpes simplex virus type 1 (HSV-1) is a severe complication of orthotopic liver transplantation (LTX). The records of patients were reviewed who had an LTX at the age of 16 years or older between 1991 and 1994 with a mean follow-up of 21 months (range, 10 to 44 months). Six patients were included who had fever of >38°C, deterioration of arterial blood gases, radiological evidence of interstitial pneumonia and proof of HSV-1 in bronchoalveolar lavage fluid. All patients were anti-HSV-IgG positive before LTX. All patients were successfully treated with intravenous acyclovir, mechanical ventilation and reduced immunosuppression. Three patients who received cyclosporin A had a rejection which was successfully treated by switching to FK 506. Four patients were discharged in good health. One patient died 36 months after LTX of an unrelated cause. One patient died of urosepsis on postoperative day 139. Acyclovir together with mechanical ventilation and reduced immunosuppression proved to be an effective treatment for HSV-1 pneumonia following LTX.
Zusammenfassung
Die von Herpes Simplex Virus Typ 1 (HSV-1) verursachte interstitielle Pneumonie ist eine schwere Komplikation der orthotopen Lebertransplantation (LTX). Wir werteten die Akten von allen Patienten über 16 Jahre aus, die 1991–1994 eine LTX erhielten mit einer mittleren Verlaufsbeobachtung von 21 Monaten (10–44 Monate). Sechs Patienten erfüllten die diagnostischen Kriterien für eine HSV-Pneumonie mit Fieber >38°C, verschlechterter arterieller Blutgasanalyse, radiologischen Zeichen einer interstitiellen Infiltration und Nachweis von HSV-1 in der bronchoalveolären Lavageflüssigkeit. Vor der Transplantation waren alle Patienten anti-HSV-IgG positiv. Alle Patienten wurden erfolgreich behandelt mit Acyclovir, Beatmung und reduzierter Immunsuppression. Drei Patienten unter Cyclosporin A hatten eine Abstoßung, die durch Umstellung auf FK 506 erfolgreich behandelt wurde. Vier Patienten wurden in gutem Zustand entlassen. Ein Patient starb 36 Monate nach LTX an einer anderen Erkrankung. Ein Patient verstarb an Urosepsis am postoperativen Tag 139. Gabe von Acyclovir, reduzierte Immunsuppression und Beatmung ist eine effektive Behandlung der HSV-1 Pneumonie nach Lebertransplantation.
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Liebau, P., Kuse, E., Winkler, M. et al. Management of herpes simplex virus type 1 pneumonia following liver transplantation. Infection 24, 130–135 (1996). https://doi.org/10.1007/BF01713317
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DOI: https://doi.org/10.1007/BF01713317